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Year 3 Top Tips > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What is ante-partum haemorrhage?

A

Bleeding from the genital tract from 24 weeks gestation before the onset of labour

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2
Q

WHat are the causes of ante-partum haemorrhage?

A

Placenta praevia

Placenta Abruption

Vasa Praevia

Uterine rupture

Varicosities

Polyps

Tumours

Trauma

Ectropian

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3
Q

How do class placenta praevia?

A

Major

Minor

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4
Q

What is placenta praevia

A

When the placenta is blocking the opening of the cervix so the baby cannot be delivered vaginally

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5
Q

Symtpms of placenta praevia

A

Painless

Vaginal bleeding

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6
Q

What are the signs of placenta praevia?

A

High presenting part

Malpresentation

soft uterus

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7
Q

What do you look for in foetal assessment

A

Foetal movements

FH Auscultation

CTG

USS

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8
Q

Is a transvaginal USS safe to do if the lady had placenta praevia?

A

Yes

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9
Q

With any bleed in a pregnant lady, what should you always check?

A

rhesus status

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10
Q

What happens if the pregnant lady is rhesus negative?

A

She will require anti-D prophylaxis to prevent haemolytic disease of the newborn

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11
Q

What is placenta abruption?

A

Placental abruption occurs when the placenta separates from the inner wall of the uterus before birth. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. In some cases, early delivery is needed

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12
Q

Classification of placenta abruption?

A

Concealed

Revealed

Both

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13
Q

Symptoms of placenta abruption?

A

Abdominal pain

Vaginal Bleeding

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14
Q

Signs of placenta abruption?

A

Woody hard uterus

Vaginal bleeding

Foetal distress, maternal shock

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15
Q

Post partum harmorrhage is a obesteric emergency

TRUE OR FALSE

A

TRUE

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16
Q

What is postpartum haemorrhage

A

Postpartum haemorrhage (PPH) is heavy bleeding after birth. PPH can be primary or secondary: • Primary PPH is when you lose 500 ml (a pint) or more of blood within the. first 24 hours after the birth of your baby.

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17
Q

What is primary postpartum haemorrhage?

A

When 500mls or more of blood is lost from the genital tract occuring within 24 hours of delivery

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18
Q

Causes of primary PPH?

A

Tone- refers to a failure of the uterus to contract

Trauma- can be caused by episiotomy, tear, haematoma, uterine inversion or a ruptured uterus.

Tissue - refers to tretained placenta membrane

Thrombin- any coagulation problem.

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19
Q

What is the most common cause of primary PPH?

A

uterine atony

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20
Q

Tx for pph?

A

Tone - uterine massage, bimanual compression. Medical and surgical management (iv oxytoxin, uterine sutture,)

Trauma- repair

Tissue- manual removal

Thrombim-Harmatology

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21
Q

What is secondary PPH

A

an excessive abnormal bleeding from the gential tract from 24 hours to 6 weeks post partum

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22
Q

Causes of secondary PPH

A

Endometritis

Retained placenta and membranes

Trauma

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23
Q

What are the indication for assisted delivery?

A

Fetal: distress

Maternal: Exhaustion/ comorbidity i.e neuro/cardiac conditions

Delay in 2nd stage of labour

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24
Q

What instruments can be used for assisted delivery?

A

Simpsons Forceps

Hand hels suction cup or ventouse

Suction cup

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25
Q

What are some important points you need to know about forceps?

A
  • Need adequate analgesia ie pudendal block/epidural
  • Less reliant on maternal effort
  • Need to do episiotomy with all forceps to minimize OASI risk
  • Always check for vaginal trauma afterwards
  • Instrument of choice for preterm infants
  • Can rotate infants with forces (in theatre)
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26
Q

What are some important points about ventouse?

A
  • Can be used with pudendal block or local infiltration (if necessary)
  • More reliant on maternal effort
  • Ensure all equipment correctly assembled and working beforehand
  • Positioning of cup important
  • Consider episiotomy (in mulliparous women)
  • Can’t use on babies <34/40, careful use <36/40 (bleeding risk)
  • Warn parents of swelling on babies head- will settle down
27
Q

Can caesarean section is only elective surgery

TRUE OR FALSE

A

FALSE

elective and emergency

28
Q

How ‘to do’ emergencies weel?

A
  • Identify high risk patients and anticipate any potential emergencies
  • take steps before hand to reduce the risk if possible
  • have appropriatley trained staff caring for woman
  • inform patient of increased risks and possibilities
  • document well- importance of a scribe
  • debrief with patient/relatives/colleagues afterwards
  • always ask for help, early
29
Q

If the babys head is delivered but finding it hard to deliver the shoulders of the baby, what is the likely diagnoses?

A

Shoulder dystocia

30
Q

What is shoulder dystocia?

A

Failure of head to deliver despite maternal effort and normal traction of head

  • the anterior shoulder impacts behind the pubic symphysis
  • disimpaction will lead to delivery
  • can cause compression of cord
  • risk of brachial plexus injury
31
Q

In an obsteric emergency (shoulder dystocia) what is a good acronym to remember?

A

HELPERR

Help- emergency buzzer

Episiotomy- evaluate for this to make more room for maneuvers

Legs- Mc Roberts position

Pressure- constant then rocking suprpubic behind anterior shoulder

Enter- finger behinf anterior shoulder, behind post shoulder, Wood screw amneuver

Remove- posterior arm grabbed

Roll- onto all fours and repeat

32
Q

What can be the complications with shoulder dystocia?

A

brachial plexus injury

erbs palsy specifically

33
Q

What is cord prolapse?

A
  • Immediate delivery via C/S- unless fully dilated and delivery imminent, could consider del in room with instrument
  • minimal handling of loops of cord
  • manually elevate the presenting part off cord or fill urinary bladder
  • mum in knee- chest position
  • consider tocolysis - if delivery is delayed
34
Q

What is eclampsia?

A

Eclampsia is the new onset of seizures or coma in a pregnant woman with preeclampsia. These seizures are not related to an existing brain condition

35
Q

Mx for eclampsia?

A
  • call for help
  • ABCDE
  • Loading dose MgSO2 (50% strength) 1g/hour infusoin for 24 hours since last seizure
  • Monitor closely- HDU setting
  • 10min observation/ hourly urine output/reflexes
  • Magnesium Toxicity (poor UO <25ml/hour, absent reflexes, RR<14, Sats<90%)
  • Consider Calciu Gluconate 10ml 10% IV
  • Treat high BP- IV infusion vs oral medication (labetalol 1st line) Amin <150/100
  • Fluid restrict (80ml/hour)- Renal failure and pulmonary oedema
  • Repeat bloods also
  • HELLP syndrome
  • Experdite delivery
36
Q

What is abnormal uterine bleeding? AUB

A

Bleeding from the uterine corpus that is abnormal in duration, volume, frequency, and/or regularity

37
Q

What is the classification used for abnormla uterine bleeding?

A

FIGO CLassifciation

38
Q

What is always classed is abnormal uterine bleeding?

A

Intermenstrual bleeding (cyclical or random)

Unschedules bleeding on hormone medication

39
Q

WHat are the causes fo AUB

A
  • *P**olyps
  • *A**denolyosis
  • *L**eimoyoma
  • *M**alignancy
  • *C**oagulopathy
  • *O**vulatory
  • *E**ndometrial
  • *I**atrogenic
  • *N**ot yet classified
40
Q

What are the medical and surgical managements for heavy menstral bleeding

A
41
Q

What does the infectious diseases screening programme screen for?

A

Hepatitis B

HIV

Syphillis

42
Q

When should screening be performed for antenatals

A

screenign should ideally be performed as early as possible in pregancy but can be performed up to and including labour

43
Q

What do you test in antenatal screening for infectious disease?

A

Materanl serum sample

44
Q

What is urinary incontinence?

A

Involuntary leakage of urine

45
Q

What is the difference between stress, urge and mixed urinary incontinence?

A

Stress UI; Incontinence on effort or physical exertion or on sneezing or coughing

Urge UI: incontinence associated with urgency

Mixed UI: UI associated with urgency and also with effort or physical exertion or on sneezing ot coughing

46
Q

What trigger could cause urinary incontinence?

A

Cough

Exercise

Intercourse

Urge to PU

Nocturia

coffee

tea

alcohol

fizzy drinks

47
Q

WHat is intialy treatment for UI

A

conservative

lifestyle modification including weightloss to keep BMI<30 and fluid adjustment and avoiding caffeine.

behaviour modication with bladder training for at least 6 weeks

Supervised pelvic floor exercises for at least 3 months

48
Q

Drugs used for Urge (UI)

A

Anticholinergics

If not tolerant can try mirabegron

49
Q

WHat are the side effects of anticholinergics?

A

be wary of giving oxybutynin to elderly women due to risk of dementia

50
Q

Investigations for urge incontinence?

A

Urodynamics: may help to determine flow pattern and confirm stress or detrusor overactibity, If confirmed DO non responsive to medication

51
Q

WHat is the next step if detrusor overactivity is confirmed?

A

Cystoscopic injection of Botulim Toxin A (Botox) to the bladder wall. Start with 100IU

Sacral Nerve stimulation

If all fails:

Augmentation cystoplasy

Urinary Diversion

52
Q

Treatment options for stress incontinence?

A

Colposuspension: Open or laproscopic

Autologous fascial sling

(Mid urethral mesh sling)

Inramural bulking agent

follow up in 6 months

53
Q

What is pop-q classification?

A

The Pelvic Organ Prolapse Quantifications System (POP-Q) is a system for assessing the degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of clinical findings.

54
Q

Treatment for pelvic floor prolapse?

A

Based on patients desire

stage 1 and stage 2: 16 weeks supervised PFE

-Vaginal oestrogen for atrophic tissue

Vaginal pessaries

surgery based on compartment involved

55
Q

When should nausea and vomiting be diagnosed in pregnancy?

A

when onsent is in the first trimester and toher causes of nausea and vomitting have been excluded

if it is after 10 weeks of gestation then other csauses need to be considered

56
Q

What is hyoeremesis gravidarum?

A

Some pregnant women experience very bad nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can impact on their daily life. This excessive nausea and vomiting is known as hyperemesis gravidarum (HG), and often needs hospital treatment.

57
Q

How is hyperemesis gravidarum diagnosed in pregnancy?

A

When there is protracted nauseas and vomiting with the traid of more than 5% of pre-preganncy weight loss, dehydration and electrolyte imbalance.

58
Q

How can the severity of nausea and vomitting be classified?

A

PUQE score

pregnancy-unique quantification of emesis and nausea

59
Q

Ix for nausea and vomitting?

A

History - exclude H. pylori

Exam

PUQE score

Urinary dipstick

Electrolytes

FBC

Blood glucose

USS

LFTs

TFTs

60
Q

What are the differential diagnosis when we see apatient with nausea and vomiting in patients?

A

peptic ulcers

cholecystitis

gastroenterisits,

hepatitis pancreatits

genitourinary condition : UTI, pyelonephritis

metabolic conditions

Neurological

drug induced

61
Q

Gastrodudenoscopy considered safe in pregnancy?

A

Yes

62
Q

What is the inital management for people with nausea and vomitting?

A

oral anti-emetics

Not tolerated then parenteral fluid, parenteral vitmains, multi and b complex vitamins

Subcutaneous metoclopramide therapy

63
Q

Theraputic options for nausea and vomittting in pregnancy?

A

Anti histamines

Phenothiazines

H2 receptor antagonists

64
Q
A

Year 3 Top Tips (19 decks)

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